Friday, 31 August 2018 19:58

Anticoagulation news items. Week commencing 27th August 2018

Revised SPCs: Xarelto (rivaroxaban)

electronic Medicines compendium

SPC revised to include a new indication; co-administration with acetylsalicylic acid for the prevention of atherothrombotic events in adult patients with coronary artery disease or symptomatic peripheral artery disease at high risk of ischaemic events.

 

Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

Journal of Clinical Oncology

RCT (n=2,373) reports preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events (VE) and incidence of significant VE was low (0.93 per 100 patient-years [95% CI, 0.61 to 1.41)]). If platelet count is < 1,500 × 109/L cytoreductive therapy is not indicated.

 

Conference report: Real-world evidence from Global Anticoagulant Registry (GARFIELD-AF) following study of non-vitamin K Antagonists oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs) in newly diagnosed atrial fibrillation

Biospace Inc.

A new analysis (n=19,134) found 19% fewer deaths in patients initiated on NOACs than VKAs at the time of diagnosis of AF (aHR 0.81 [95% CI 0.71- 0.92]; p<0.001).

 

Antifibrinolytics for heavy menstrual bleeding

Cochrane Database of Systematic Reviews

Review of 13 RCTs (n=1312) found antifibrinolytics (such as tranexamic acid) appears effective for treating heavy menstrual bleeding vs. placebo, NSAIDs, oral luteal progestogens, ethamsylate, or herbal remedies, but may be less effective than levonorgestrel intrauterine system.

 

Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus

New England Journal of Medicine

RCT (n=15,480) found aspirin prevented serious vascular events in diabetic patients and no CVD (8.5 v. 9.6%; rate ratio 0.88; 95% CI, 0.79-0.97; p=0.01) but also caused major bleeding (4.1 v 3.2% 1.29; 1.09-1.52; p=0.003); absolute benefits were outweighed by bleeding hazard.

 

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness

New England Journal of Medicine

RCT (n=12,024) found rivaroxaban given to medical patients for 45 days after hospital discharge was not linked to a significantly lower risk of symptomatic venous thromboembolism and death due to venous thromboembolism than placebo (0.83% rivaroxaban vs. 1.10% placebo; p=0.14).

 

Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease

New England Journal of Medicine

RCT (n=5022) found rivaroxaban 2.5mg twice daily was not linked to significantly lower rate of death, myocardial infarction, or stroke than placebo among patients with worsening chronic heart failure, reduced left ventricular ejection fraction, coronary artery disease, and no AF.

 

Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent

The Lancet

RCT (n=15,968) found ticagrelor (TC) plus aspirin for 1 month followed by TC alone for 23 months was not superior to 12 months of standard dual antiplatelets followed by 12 months of aspirin alone in prevention of all-cause mortality or new Q-wave MI 2 years after PCI.

 

US FDA approves Jivi (recombinant factor VIII concentrate) for haemophilia A

Biospace Inc.

It has been approved for use in previously treated adults and adolescents (≥12 years) for on-demand treatment and control of bleeding episodes, perioperative management of bleeding, and routine prophylaxis to reduce the frequency of bleeding episodes.

 

 

The above records have been identified by UKMi and feature in the NICE Medicines Awareness Service. Further details on this service can be found at:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services